Quality of care for Integrated HIV, TB and Malaria services in antenatal and postnatal care facilities

IntroductionThe Centre for Maternal and Newborn Health is working in collaboration with implementing partners and governments in host countries to deliver an implementation research programme for quality improvement of integrated HIV, TB and malaria services in antenatal (ANC) and postnatal care (PNC).

This programme is funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and aims to deliver a quality improvement process that can be used to systematically assess and improve the availability, quality and efficiency of integrated HIV, TB and Malaria services provided at health facilities and thus improve outcomes. A core component of the programme will be measuring and sharing “what works, why and how”.

Implementation of the programme started in Afghanistan, Ghana and Togo in 2017. We are currently working on plans to expand the programme in these countries, as well as to additional countries including Chad and Nigeria. In addition, Global Fund-supported work is currently underway in Niger, where we are conducting a comprehensive assessment of the quality of maternal, neonatal and child care.

Brief background Pregnant women and newborns represent a high-risk group for HIV, TB and malaria. However, antenatal care is a success story all over the world, and provides an excellent entry point for care of the pregnant woman and her newborn for HIV, TB and malaria. As such, countries could benefit from a systematic approach for quality improvement of integrated care for mothers and newborns in antenatal and postnatal care.

This work is innovative, will provide strategic directions for programme quality and will contribute to the body of implementation research on quality assurance and integrated, people-centred health services to improve health outcomes.

ActivitiesThis is a phased multi-country programme that uses a catalytic approach to produce sustainable, measurable improvements in the availability and quality of HIV, TB and malaria services integrated in ANC and PNC in selected health facilities in each country.

Key activities of the introductory phase of the programme include:

a baseline assessment of the availability, functioning and utilisation of services at participating health facilities

setting standards for ANC and PNC

skilled and competency-based training of healthcare providers in ANC and PNC

introduction of a quality improvement process: Standards-Based Audit.

These interventions will be introduced to participating health facilities in a phased manner, with regular monitoring and evaluation to monitor the process and outputs of implementation. Studies of maternal and newborn morbidity are planned to assist in the evaluation of outcomes.

Related/previous programmesThis work builds on the Making It Happen programme which focused on improving obstetric care during labour and delivery, by extending work into the antenatal and postnatal period.